Evaluation of the safety and effectiveness of nevirapine plus coformulated tenofovir/emtricitabine as first-line therapy in routine clinical practice.

Despite having demonstrated noninferior efficacy against atazanavir/ritonavir plus coformulated tenofovir/emtricitabine (cTDF/FTC), the combination of nevirapine plus cTDF/FTC is not included among preferred regimens in some international guidelines. This combination is frequently used in Spain. We analyzed its effectiveness and safety as first-line therapy in a routine clinical practice. A retrospective, multicenter study was performed in treatment-naive HIV-1-infected subjects who started nevirapine plus cTDF/FTC as first-line therapy according to the nevirapine CD4(+) cell count threshold. The primary endpoint was the proportion of subjects with plasma HIV-1 RNA <50 copies/ml at week 48. We included 123 subjects starting the regimen from 2005 to 2008. The median age was 41.0 years, the median baseline CD4(+) cell count was 215 cells/µl, the median plasma viral load (VL) was 4.83 log(10) copies/ml, and 22% had hepatitis C coinfection. At week 48, 96 subjects (78%; 95% CI: 69.9-84.4) had a VL <50 copies/ml in an ITT analysis, and the median rise in the CD4(+) cell count was 118 cells/µl. Virological failure was observed in 6.5% (8/123) of subjects, all them before week 24 and related to poor adherence. There was no relationship between virological failure and baseline CD4(+) cell count or VL. Ten percent (13/123) of the subjects discontinued the treatment due to adverse events. There was a significant decrease in total/HDL-cholesterol ratio (p=0.03) with an increase in HDL-cholesterol (p=0.01) over 48 weeks. The combination of nevirapine plus cTDF/FTC showed a high virological efficacy without unexpected toxicities as a first-line treatment in a routine clinical practice.

Manifestaciones oculares del síndrome de apnea del sueño / Ocular disease in sleep apnea syndrome

El síndrome de apnea del sueño se caracteriza por episodios repetidos de colapso total o parcial de la vía aérea superior durante el sueño. En los últimos años, esta enfermedad se ha asociado a un incremento de morbimortalidad de origen cardiovascular. Más recientemente, se ha reconocido su relación con ciertos procesos oftalmológicos. Éstos incluyen el síndrome del párpado flácido, el glaucoma, la neuropatía óptica isquémica no arterítica y el papiledema. En este artículo, y sobre la base de las pruebas disponibles, se discute acerca de estas asociaciones y de los mecanismos fisiopatológicos que vinculan el síndrome de apnea del sueño y la salud ocular. El conocimiento de estas asociaciones por parte del oftalmólogo, el médico de familia y el especialista en trastornos del sueño es necesario para un mejor diagnóstico y tratamiento de estos pacientes (AU)

leep apnea syndrome is characterised by recurrent episodes of partial or complete upper airway flow interruption during sleep. In the last twenty years, the relationship of sleep apnea with cardiovascular disease has been recognised. More recently, several ocular disorders have been associated with sleep apnea syndrome, including floppy eyelid syndrome, glaucoma, non-arteritic ischemic optic neuropathy and papilledema. Based on the published evidence, we discuss these associations along with the possible pathophysiological mechanisms and clinical management. It is needed that the ophthalmologist, the primary care physician and the sleep physician are aware of this association so that both sleep disorders and the related ophthalmologic disorders can be better diagnosed and treated (AU)

[Ocular disease in sleep apnea syndrome]. / Manifestaciones oculares del síndrome de apnea del sueño.

Sleep apnea syndrome is characterised by recurrent episodes of partial or complete upper airway flow interruption during sleep. In the last twenty years, the relationship of sleep apnea with cardiovascular disease has been recognised. More recently, several ocular disorders have been associated with sleep apnea syndrome, including floppy eyelid syndrome, glaucoma, non-arteritic ischemic optic neuropathy and papilledema. Based on the published evidence, we discuss these associations along with the possible pathophysiological mechanisms and clinical management. It is needed that the ophthalmologist, the primary care physician and the sleep physician are aware of this association so that both sleep disorders and the related ophthalmologic disorders can be better diagnosed and treated.

Cirugía urgente del colon ocluido, perforado o sangrante. Estudio multicéntrico de 38 hospitales* / Emergency surgery of the obstructed, perforated or bleeding colon. Multicenter study of 38 hospitals

Introducción. Presentamos un estudio con objeto de analizar la intención teórica diagnóstica y terapéutica ante cuadros oclusivos, perforativos o sangrantes de colon, así como la experiencia real. Material y método. Elaboramos una base de datos, que hicimos llegar a los servicios de cirugía de los hospitales catalanes, solicitando su propuesta diagnóstica y terapéutica ante cuadros de oclusión, perforación o sangrado de colon. La segunda parte del estudio ha consistido en recopilar los datos reales durante los años analizados. Resultados. Obtuvimos la respuesta de 38 hospitales y recopilamos los casos de 6.561 pacientes operados de enfermedades colónicas. De las operaciones urgentes, 1.113 correspondieron a adenocarcinomas y 578 a enfermedades benignas. La proporción de las enfermedades quirúrgicas urgentes ha sido de un 61 por ciento para los cuadros oclusivos, de un 33 por ciento para las perforaciones de colon y de un 6 por ciento para el sangrado de colon. Conclusiones. A pesar de que la mayoria de cirujanos en teoría son partidarios de la cirugía en un solo tiempo, la operación de Hartmann sigue siendo la más empleada en los cuadros oclusivos y, sobre todo, en las perforaciones colónicas, salvo en algunos centros, sin que haya ninguna relación con el nivel del hospital (AU)

Treatment of chronic hepatitis C in HIV-infected patients with interferon alpha-2b plus ribavirin.

One hundred six HIV-infected patients with chronic hepatitis C virus (HCV) infection were randomized to receive ribavirin (RBV) 400 mg bid plus interferon alpha-2b (IFN-alpha) at two different doses, 3 mU tiw (control arm) or 5 mU daily for the first 6 weeks, followed by 3 mU tiw until completing 6 months of therapy (induction arm). All patients had CD4 counts above 350 cells/microl and 89% were taking antiretroviral therapy. Adverse effects leading to treatment discontinuation occurred in 12.3% of patients, a rate quite similar to that seen in HCV-monoinfected patients. Negative serum HCV-RNA values (< 60 IU/ml) were recorded in 24.7% and 35.5% of patients at 3 and 6 months of therapy. However, in the intent-to-treat analysis, sustained response was reached by only 16% of patients (22.4% in the on-treatment analysis). No differences between treatment arms were noticed. Patients with HCV genotypes 2 or 3 had a 7-fold higher response rate than those with HCV genotypes 1 or 4. Therefore, early, end-of-treatment, and sustained response rates are lower in HIV/HCV-coinfected patients treated with RBV/IFN-alpha combination therapy. Since HCV-related liver disease is currently one of the leading causes of morbidity and mortality among HIV-infected patients, new treatment options are urgently needed for coinfected individuals.